Jenny Wang, PT, DPT, MS

loutclankedAI and Robotics

Nov 13, 2013 (3 years and 8 months ago)

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Jenny Wang, PT, DPT, MS

Swedish Medical Center

Englewood, CO



Discuss how robotics can enhance training,
learning, and rehabilitation goals.



Selecting appropriate patients and outcome
measures.


Class of robots that can integrated into
rehabilitation programs at home, in health
care settings, at work, or in the community
to enhance function.



Integrated as a tool to enhance the
effectiveness of one on one therapy to
promote recovery, independence, and
maximal function.


Learning based robotic systems include
virtual reality, games for memory, and
technology to improve physical performance



Enables patient to perform quality
controlled, repetitive, progressive, task
-

oriented practice to improve learning


Bioness systems


Tibion Bionic leg




Can be classified as non
-
wearable or wear
-
able



Robotic exoskeleton placed
on patient’s leg during
training.


Provides mechanized assistance for patient
initiated active movement


Flexible plantar pressure
-
sensing shoe insert


Loose fitting plastic ankle straps attaching the
shoe insert without providing ankle support


Leg and thigh uprights


Single axis knee joint with angle sensors


Textile straps secured with zippers


Velcro and adjusting knobs


Onboard actuator motors with control panel
housing


Rechargeable lithium battery


Plantar pressure sensors detect gait phases
through weight bearing


Angle sensors detect knee motion angles


Actuator torque sensors determine knee
torque



Maximizes neural plasticity and recovery of
motor control, sensation, and physical skills
through controlled, progressive repetition



Improves endurance, quality of movement,
more complete task performance,
independence, and quality of life



Task specific training focused on functional
tasks like transfers, gait training, and stairs


During stance phase, stair climbing, and
sit>stand movements, knee actuator assists
knee concentric extension.


During toe off and non
-
weight bearing
conditions, actuator decouples and allows for
free knee swing.


Patient initiated knee extension with weight
bearing triggers mechanically assisted knee
extension based on programming.


Resistance and timing parameters can be set
by P.T. based on patient performance.


Weight: 110
-
300 lbs.


Start force: weight on foot plate required to
initiate powered assist


Assist factor: amount of knee extension
assistance provided (concentric)


Resist factor: amount of knee extension
assistance provided during flexion (eccentric)


Assist extension limit: degree of extension
through which assistance is provided. Helps
limit knee hyperextension when present



Patient population:


Comprehensive Rehab unit (amputees,
orthopedics/multi
-
trauma)


CVA*


Brain tumors


SCI


TBI


MS


PD



Patient motivation


Physical/cognitive ability to use and follow
multi
-
step directions


Height



Stroke patients with the most consistent
outcomes



59
yo

female


Medical history: L
pontine

and
cerebellar

ischemic infarcts, basilar artery thrombosis
s/p TNK and stent angioplasty


Past medical history: R femur fracture s/p IM
nailing from auto accident 30 yrs ago,
dyslipidemia
, pre
-
HTN, migraines


Premorbid

functional status: Independent
with functional mobility and ADLs, working
full time as dental assistant


Discharged from rehab unit after 4 weeks
with supervision/assistance from family


Impairments: Mobility and Strength


Bed mobility: Minimal assistance


Transfers: Minimal
-
Moderate assistance


Gait: Ambulate 2 steps forward w/out UE
support, Min
-
Max Assist for balance and R foot
placement. Trendelenburg and Genu Recurvatum
on RLE.


Right leg strength


Hip flexion 2
-
/5


Knee flexion 2
-
/5


Knee extension 2
-
/5


Dorsiflexion 0/5



Functional status: bed mobility, transfers,
gait, stairs


Five time sit to stand


Body structure and function Domain of ICF model
of disability


Measures:


Lower limb strength and function


Balance and mobility


Predictor of recurrent falls


General test of physical performance


Correlates with DGI, TUG, Gait speed, BBS






Gait speed


Activity Domain


Measures:


Motor control


Muscle performance


Endurance and activity level


Musculoskeletal condition


Correlates with discharge location, additional
need for rehabilitation, functional status


Indicator for household ambulator, limited
community ambulator, or community ambulator




Projected functional goals at discharge
established at initial evaluation


Bed mobility


Transfers


Gait


Stairs


Initial treatment aimed at quality of
movement ie. trunk control, hip stability,
midline orientation, safety with mobility, and
lower extremity activation.



Based on principles of motor control and
learning, performed function based training
using
Tibion

Bionic leg initially for standing
weight shifting, sit><stand, then gait.


Tibion

initiated on Day 9 for gait training, after
interventions addressing safety, midline
orientation, knee control, appropriate hip
stability, and trunk control/alignment.


Continual intervention for functional mobility in
conjunction with use of
Tibion

and Bioness L300.


Also participating in 1.5 hrs of OT and 1 hr of SLP
services

Threshold

Assistance

Resistance

Day 1

5

85

High

Day 2

5

85

Medium

Day 3

10

80

Medium

Day 4

10

75

Medium

Day 5

10

75

Medium

Day 6

15

75

Medium

Initial Evaluation

Discharge

Bed

mobility

Minimal

Assistance

Independent

Transfers

Minimal
-
Moderate

Assistance

Stand by assistance

Gait

2

Steps Moderate
-

Maximal Assistance

Cane,

R AFO x 150 ft Contact
guard assistance

Stairs

NA

Up/down

7 inch curb w/ cane
and AFO, Minimal Assistance. 10
steps w/ rail, Contact guard
assistance

Five

time sit to stand

31 sec

17 sec

Gait speed

0.4

m/s

0.8 m/s

RLE

status


Hip Flexion


Knee Extension


Knee Flexion


Dorsiflexion


2
-
/5

2
-
/5

2
-
/5

0/5


3/5

2+/5

3/5

1/5

Long Term Goals

Status

Bed mobility: Independent

Goal

Met

Transfers: SBA

Goal

Met

Gait: Ambulate

with cane, SBA
on indoor surface

Goal

not Met

Stairs: Up/down

flight of stairs
w/ cane or rail, CGA

Goal Met


Challenges:


Not available for personal rental for home use


Difficult fit for smaller stature/petite patients